Med Surge 2
1. Emphysema Clinical manifestation: Destruction of the alveoli-decrease
elasticity of the lungs.
Retaining Co2 acidic pH, low Pao2<80
Thin, wasted leaning forward
Barrel chest: due to air trapped
SOB, using accessory muscle
Productive cough: How can we help them to clear their airway?
We send them home with mucolytic (Acetylcysteine)
Hydration to thin out the secretions
Use pursed lip breathing and diaphragmatic breathing
Give low flow O2.
2. Signs and symptoms of O2 toxicity: remove the O2
Spo2 will drop
Increase use of accessory muscles
Tachypnea >20Bpm
Ph: <7.35 acidic, Pao2: <80, PaCo2: >45 acidic. Hypoventilation.
They will take the orthopneic position: leaning forward with their
hands on their thigh.
3. What is the risk factor for sleep apnea?
Obesity and AGE: Lose weight and we use CPAP and BiPAP
Smoking, short neck, enlarge tonsils
4. Daytime Hypoventilation syndrome what do we do?
They must be in an UPRIGHT POSITION or HOB at least 30 degrees
Tell them to lose weight
, DO NOT LET THEM WALK
5. Sarcoidosis: no cure pt will die from pneumonia
systemic infection, mostly lungs and lymph nodes
They have Granulomas
They have frequent pneumonia
How do we treat it?
Corticosteroids (Prednisone) for the lungs: Check their Blood sugar and
monitor for infection
NSAID for pain.
6. To confirm the diagnose TB we need a positive Acid-Fast Bacillus
sputum test. How do we collect the sputum?
Rinse mouth and Cough and deep breath
7. What is the difference between having a positive TB test and active TB?
Active: elderly, Immune compromised, Diabetes:
Positive but not active: Healthy patient
8. For active TB we give the patient INH for 6-12months what do we teach
them?
avoid foods with thiamine (cheese, red wine, soy sauce, and yeast)
We will have your liver enzymes and kidney function checked every
month.
DO NOT DRINK ALCOHOL or TAKE TYLENOL.
9. If the patient has signs and symptoms of TB like night sweat tell them to
go the hospital immediately. What are the other signs and symptoms of
TB?
Low grade fever in the late afternoon hours
Fatigue
Unexplained weight loss
1. Emphysema Clinical manifestation: Destruction of the alveoli-decrease
elasticity of the lungs.
Retaining Co2 acidic pH, low Pao2<80
Thin, wasted leaning forward
Barrel chest: due to air trapped
SOB, using accessory muscle
Productive cough: How can we help them to clear their airway?
We send them home with mucolytic (Acetylcysteine)
Hydration to thin out the secretions
Use pursed lip breathing and diaphragmatic breathing
Give low flow O2.
2. Signs and symptoms of O2 toxicity: remove the O2
Spo2 will drop
Increase use of accessory muscles
Tachypnea >20Bpm
Ph: <7.35 acidic, Pao2: <80, PaCo2: >45 acidic. Hypoventilation.
They will take the orthopneic position: leaning forward with their
hands on their thigh.
3. What is the risk factor for sleep apnea?
Obesity and AGE: Lose weight and we use CPAP and BiPAP
Smoking, short neck, enlarge tonsils
4. Daytime Hypoventilation syndrome what do we do?
They must be in an UPRIGHT POSITION or HOB at least 30 degrees
Tell them to lose weight
, DO NOT LET THEM WALK
5. Sarcoidosis: no cure pt will die from pneumonia
systemic infection, mostly lungs and lymph nodes
They have Granulomas
They have frequent pneumonia
How do we treat it?
Corticosteroids (Prednisone) for the lungs: Check their Blood sugar and
monitor for infection
NSAID for pain.
6. To confirm the diagnose TB we need a positive Acid-Fast Bacillus
sputum test. How do we collect the sputum?
Rinse mouth and Cough and deep breath
7. What is the difference between having a positive TB test and active TB?
Active: elderly, Immune compromised, Diabetes:
Positive but not active: Healthy patient
8. For active TB we give the patient INH for 6-12months what do we teach
them?
avoid foods with thiamine (cheese, red wine, soy sauce, and yeast)
We will have your liver enzymes and kidney function checked every
month.
DO NOT DRINK ALCOHOL or TAKE TYLENOL.
9. If the patient has signs and symptoms of TB like night sweat tell them to
go the hospital immediately. What are the other signs and symptoms of
TB?
Low grade fever in the late afternoon hours
Fatigue
Unexplained weight loss
